ToursGaGa

Title	Special precautions
Diphtheria	Yes
Hepatitis A	Yes
Malaria	Sometimes*
Rabies	Sometimes
Tetanus	Yes
Typhoid	Yes
Yellow Fever	Yes**

* Malaria risk exists throughout the year at altitudes below 900m (2,953ft) in Acre, Amapá, Amazonas, Maranhão, Mato Grosso, Pará, Rondônia, Roraima and Tocantins states, as well as some larger cities, such as on the periphery of Pôrto Velho, Boa Vista, Macapá, Manaus, Santerém, Rio Branco and Maraba.

** Brazil is currently experiencing an outbreak of yellow fever. The World Health Organisation recommend a vaccination against yellow fever for all international travellers visiting the states of Rio de Janeiro, São Paulo and Bahia. A yellow fever vaccination is also strongly recommended for those intending to visit rural areas and certain inland cities like Brasília. A vaccination certificate is required from all travellers arriving from Angola and the Democratic Republic of Congo.

Health Care

Brazil is considered to have a high risk of Zika virus transmission. The mosquito-borne illness can be spread from a pregnant woman to her unborn baby as well as through sexual contact. The World Health Organisation recommends travellers to Brazil protect themselves from mosquito bites and suggests wearing clothes (preferably light-coloured) that cover as much of the body as possible, sleeping under mosquito nets and using repellents that contain DEET (diethyltoluamide), IR 3535 ((3- [N-butyl-N-acetyl], aminopropionic acid ethyl-ester) or KBR3023 (also called Icaridin or Picaridin). Pregnant women are advised to postpone non-essential travel until after pregnancy and pregnant women whose sexual partners live in or travel to areas with Zika virus transmission should follow safe sexual practices or abstain from sex for the duration of their pregnancy. Women who are pregnant, at risk of getting pregnant, or planning pregnancy should seek further advice from their doctor before travelling to Brazil.

There is no reciprocal health agreement with the UK or USA. Full insurance is strongly recommended as medical costs are high. The standard of medical care is generally very good in major towns and cities. English-speaking medical staff are found mainly in São Paulo and Rio de Janeiro.

Public health care services in Brazil are free of charge, but may only be used by foreign tourists in the event of an emergency. The main hospital in São Paulo is the Hospital das Clínicas, while in Rio the Hospital Copa D’Or and the Hospital Samaritano are both well regarded. In the event of a medical emergency, call 192 for an ambulance.

Food and Drink

Tap water should not be drunk unless boiled or sterilised first. Even filtered water in more remote areas should be avoided and bottled water should be drunk instead. Pasteurised milk and cheese is generally considered safe to consume. Milk outside of urban areas is unpasteurised and should be boiled; travellers should also be wary of products that could have been made with unpasteurised milk, such as ice cream. Only eat well-cooked meat and fish and avoid ice cubes in cold drinks. Vegetables should be cooked and fruit peeled.

Other Risks

Bilharzia (schistosomiasis) is present within Brazil, as are several other infectious diseases such as chikungunya and dengue fever (which are more prevalent after rain in densely populated areas). There have also been cases of meningococcal meningitis in and around the Bahia area. Rabies is present; if you are bitten, seek medical advice without delay. If visiting remote parts of the Amazon or more rural villages, be sure to take the usual precautions, stocking up on mosquito repellent, sunscreen lotion and wearing suitable clothing.